Risk factors for non-fatal myocardial infarction and cardiac death in incident dialysis patients

Background. The risks of major cardiac events in patients initiatinglong-term dialysis related to prior coronary disease and variousother factors are not well known. Methods. We used United States Renal Data System data to analysethe outcomes of non-fatal myocardial infarction (MI) and cardiacdeath in incident dialysis patients from years 1997 through2001 (n = 214 890). The presence of established coronaryartery disease was determined from the Medical Evidence form,non-fatal MI events were determined from Medicare claims’data and cause of death was determined from the Death Notificationform. Multivariable analyses were performed employing Cox proportionalhazards models using demographics, co-morbidities, laboratoryvariables, prior erythropoietin use, body mass index and typeof dialysis. Results. In patients with prior coronary disease as comparedto those without, the adjusted relative risk of non-fatal MIwas 1.57 (95% CI, 1.5–1.65) and cardiac death was 1.16(95% CI, 1.14–1.18). The 5-year cumulative incidence ofnon-fatal MI was 8.1 and 6% and cardiac death was 48.3 and 40.2%,in patients with and without prior coronary disease, respectively.Amongst important factors, blacks had a lower risk of non-fatalMI and cardiac death as compared to whites. A history of hypertensionconferred a lower independent risk of cardiac death events.Lower haemoglobin, higher albumin and higher creatinine valueseach conferred a lower independent risk of non-fatal MI andcardiac death. Conclusions. Incident dialysis subjects with prior coronarydisease have a risk of non-fatal MI greater by 57% and cardiacdeath by 16% as compared to subjects without prior coronarydisease. In both populations, the competing risk of cardiacdeath is several-fold greater than that of non-fatal MI. Thereare several factors suggesting reverse epidemiology phenomenawith respect to major cardiac events in the dialysis population.